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World TB Day: Rates Are Rising to Pre-Pandemic Levels

Although case numbers are still lower than in 2019, data indicates tuberculosis (TB) incidences are beginning to rise, especially among specific populations.

The COVID-19 lockdowns not only lessened exposure to SARS-CoV-2, but they may have also reduced the spread of other illnesses, such as tuberculosis (TB). For example, in 2020, the incidence of TB was 2.2 cases per 100,000 people in the United States. This number was less than the 2.7 cases per 100,000 in 2019.

Lower rates in 2020 were likely due to less travel and human interaction. However, they might also reflect delayed or missed TB diagnoses due to difficulty accessing healthcare.

On March 24, the CDC released its latest Morbidity and Mortality Report highlighting the latest data on the incidence of TB. And according to the report, TB is returning to pre-pandemic levels in the U.S.

The report’s release date aligns with World TD Day, an annual event honoring Robert Koch’s announcement on March 24, 1882, of his discovery of Mycobacterium tuberculosis, the bacillus that causes TB.

According to the report, 2021 data shows the incidence of TB was 2.4 cases per 100,000 people. In 2022, 8,300 TB cases were reported to the National Tuberculosis Surveillance System, increasing the prevalence to 2.5 cases per 100,000 people.

Rates remain lower than they were in 2019

Compared to 2021, in 2022, there were more TB diagnoses among non–U.S.-born persons newly arrived in the U.S. (73% of all cases reported), non-Hispanic American Indian or Alaska Native, and non-Hispanic Native Hawaiian or other Pacific Islander persons.

Moreover, California reported the highest number of TB cases, while Alaska reported the highest TB incidence.

The CDC suggests that the higher incidence of TB among non–U.S.-born persons might reflect a post-pandemic migration increase.

Compared with 2021, 2022 saw a significant increase in TB cases among four-year-olds and people 15 to 24. On the other hand, adults 65 years or older experienced a decrease in TB cases. However, the decline observed in this age group might result from higher COVID-19 mortality rates among older adults.

Although the CDC says preventing TB transmission in the U.S. remains a priority, more than 80% of TB cases in the U.S. are caused by latent TB infections (LTBIs). LTBI occurs when TB bacteria, already in the body, reactivates and causes illness.

Therefore, the U.S. Preventive Services Task Force recommends testing and treatment for people at higher risk for LTBI. This includes non–U.S.-born persons and those living in places where people congregate, such as prisons and long-term living facilities.

In addition, the CDC says that higher TB incidence among non-Hispanic American Indian or Alaska Native and non-Hispanic Native Hawaiian or other Pacific Islander people indicates an ongoing health disparity in the U.S.

To combat these disparities, the CDC is raising awareness through the Think. Test. Treat TB campaign. This campaign offers resources in multiple languages for general audiences and healthcare providers in at-risk communities.

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